Provider Demographics
NPI:1508397936
Name:LAU, KARRIE KA WAI (DO)
Entity Type:Individual
Prefix:
First Name:KARRIE
Middle Name:KA WAI
Last Name:LAU
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 CONSTELLATION DRIVE
Mailing Address - Street 2:
Mailing Address - City:MISSISSAUGA
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:L5R 2X3
Mailing Address - Country:CA
Mailing Address - Phone:626-726-7336
Mailing Address - Fax:
Practice Address - Street 1:465 W PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3320
Practice Address - Country:US
Practice Address - Phone:559-791-3880
Practice Address - Fax:559-791-3831
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A17865207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine